NEW YORK (Reuters)
 The biggest risk that Middle
East Respiratory Syndrome will become a global epidemic, ironically, may
lie with globe-trotting healthcare workers.

From Houston to Manila, doctors and nurses are
recruited for lucrative postings in Saudi Arabia, where MERS was
first identified in 2012. Because the kingdom has stepped up hiring
of foreign healthcare professionals in the last few years, disease
experts said, there is a good chance the MERS virus will hitch a
ride on workers as they return home.

"This is how MERS might spread around the world," said infectious
disease expert Dr Amesh Adalja of the University of Pittsburgh
Medical Center.

It can take five to 14 days for someone infected with MERS to show
symptoms, more than enough time for a contagious person to fly to
the other side of the world without being detectable. Healthcare
workers "are at extremely high risk of contracting MERS compared to
the general public," Adalja said.

The threat has attracted new attention with the confirmation of the
first two MERS cases in the United States. Both are healthcare
workers who fell ill shortly after leaving their work in Saudi
hospitals and boarding planes bound west.

About one-third of the MERS cases treated in hospitals in the Saudi
Red Sea city of Jeddah were healthcare workers, according to the
World Health Organization.

Despite the risk, few of the healthcare workers now in, or planning
to go to, Saudi Arabia are having second thoughts about working
there, according to nurses, doctors and recruiters interviewed by
Reuters.

Michelle Tatro, 28, leaves next week for the kingdom, where she will
work as an open-heart-surgery nurse. Tatro, who typically does
13-week stints at hospitals around the United States, said her
family had sent her articles about MERS, but she wasn't worried.

"I was so glad to get this job," she told Reuters. "Travel is my
number one passion."

So far, international health authorities have not publicly expressed
concern about the flow of expatriate medical workers to and from
Saudi Arabia.

"There is not much public health authorities or border agents can
do, said infectious disease expert Dr Michael Osterholm of the
University of Minnesota. "Sure, they can ask people, did you work
in a healthcare facility in Saudi Arabia, but if the answer is yes,
then what?"

Healthcare workers are best placed to understand the MERS risk,
Osterholm said, and "there should be a heightened awareness among
them of possible MERS symptoms."

Neither the Centers for Disease Control and Prevention nor the
Department of Homeland Security responded to questions about whether
they were considering monitoring healthcare workers returning to the
United States.

SOARING DEMAND

In the last few years, the number of expatriates working in Saudi
Arabia has soared, said Suleiman Arabie, managing director of
Houston, Texas-based recruiting firm SA International, with
thousands now working in the kingdom.

About 15 percent of physicians working in the kingdom are American
or European, and some 40 percent of nurses are Filipino or
Malaysian, according to estimates by recruiters and people who have
worked in hospitals there.

The majority of U.S.-trained medical staff are on one- or two-year
contracts, which results in significant churn as workers rotate in
and out of Saudi medical facilities.

The Saudi government is building hundreds of hospitals and offering
private companies interest-free loans to help build new facilities.
Its healthcare spending jumped to $27 billion last year from $8
billion in 2008. Building the hospitals is one challenge, staffing
them with qualified personnel is another.

Arabie's firm is trying to fill positions at two dozen medical
facilities in Saudi Arabia for pulmonologists, a director of
nursing, a chief of physiotherapy and scores more.

Doctors in lucrative, in-demand specialties such as cardiology and
oncology can make $1 million for a two-year contract, recruiters
said.

Nurses' pay depends on their home country, with those from the
United States and Canada earning around $60,000 a year while those
from the Philippines get about $12,000, recruiters said. That
typically comes with free transportation home, housing, and 10 weeks
of paid vacation each year. For Americans, any income under about
$100,000 earned abroad is tax-free, adding to the appeal of a Saudi
posting.

One Filipina nurse, who spoke anonymously so as not to hurt her job
prospects, told Reuters that she was "willing to go to Saudi Arabia
because I don't get enough pay here." In a private hospital in
Manila, she made 800 pesos (about $18) a day.

"I know the risks abroad but I'd rather take it than stay here," she
said. "I am not worried about MERS virus. I know how to take care of
myself and I have the proper training."

None of Arabie's potential candidates "have expressed any concern"
about MERS. Only one of the hundreds of professionals placed by
Toronto-based medical staffing firm Helen Ziegler & Associates Inc.
decided to return to the United States because of MERS, it said, and
one decided not to accept a job in Jeddah she had been hired for.

Recruitment agencies in Manila have also continued to send nurses to
the kingdom since the MERS outbreak, said Hans Leo Cacdac, the head
of the Philippine Overseas Employment Administration. The government
advises that returning workers be screened for MERS, Labour and
Employment Secretary Rosalinda Baldoz said this week.

Expat healthcare workers now working in Saudi Arabia feel confident
local authorities are taking the necessary steps to combat the
spread of MERS in hospitals.

"Just today they came and put up giant posters in our hospital on
MERS," said Dr Taher Kagalwala, a pediatrician originally from
Mumbai who works at Al Moweh General Hospital in a town about 120
miles from Tai'f city in western Saudi Arabia

"I have not heard of or seen any healthcare workers looking to leave
their jobs or return to their countries because of the MERS panic.
If it was happening, there would have been gossip very soon."